Long Term Antibiotics in COPD

Azithromycin has been shown in studies to reduce the COPD exacerbation rate.

Azithromycin oral 250mg daily or 500mg three times weekly (off-label use) is most commonly used. It is recommended that the prescribing of azithromycin is under the recommendation of a specialist respiratory physician. 

It is important before prescribing to consider the associated risks, only prescribe in appropriate patients and ensure treatment is reviewed regularly:

• Macrolide antibiotics carry a risk of QTc prolongation, with resulting arrhythmia and sudden cardiac death, although azithromycin does carry the lowest risk of QTc prolongation of all macrolides.
• Hearing loss and bacterial resistance are also other adverse effects to be considered.
• A baseline ECG should be performed to rule out prolonged QTc interval and baseline liver function tests. Further information on QT interval prolongation can be found in the Drug-induced QT Prolongation guideline and www.crediblemeds.org (login required).
• Given the risks, azithromycin as long term prophylaxis should not be prescribed for everyone with COPD (N.B. it has been shown that azithromycin is not known to be effective in current smokers).